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Review Types
QIO's are required to perform individual case review to fulfill mandatory review requirements (See §4100).Mandatory review categories include alleged anti-dumping violations, requests for assistants at cataract surgery for specific codes, beneficiary complaints, beneficiary's request for immediate review of hospital discharge, hospital-requested higher-weighted Diagnosis Related Groups (DRG) adjustments, potential gross and flagrant violations in one or more instances or substantial violations in the substantial number of cases (See Chapter 9).
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- Medicare Contract Number: QIO:HHSM-500-2011-FL10C ESRD:500-2010-NW007C
FMQAI 5201 W. Kennedy Boulevard Suite 900 • Tampa, Florida 33609-1822
